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The Secretary of State for Health (Mr. Alan Milburn): All 95 health authorities will have commissioned some services for their populations outside their region in the past 12 months, mainly for specialised services that are provided in relatively few hospitals in different parts of the United Kingdom.
Rev. Martin Smyth: I appreciate the difficulty in assessing what is happening and I welcome the fact that some people have recently been treated in France. Is it possible that, instead of caring for patients, health authorities that could not deal with waiting lists have refused to purchase elsewhere in order to protect jobs in their areas?
Mr. Milburn: As the hon. Gentleman knows, we want to move from the traditional position whereby hospitals choose patients to one whereby patients have a greater say about their hospital treatment. The scheme to treat some patients in France is only a pilot scheme. The hon. Gentleman would rightly be the first to express anxiety if quality of care lapsed or if we did not get value for money. It is important to test schemes and get them right. Although they will be an important option in providing more choice for patients, I suspect that many patients will choose not to choose.
Mr. Milburn: As I have said to my hon. Friend on more than one occasion, both in the Chamber and before the Select Committee, there is no blank cheque. It is important that we can guarantee the right things to patients and to taxpayers: first, the highest possible standards of care and, secondly, good value for money. When there is spare capacity in the private sector, we should use it for the benefit of NHS patients, provided that the private sector passes those two important tests. Furthermore, as my hon. Friend is well aware, capacity in the mainstream national health service continues to be built, involving more beds, more hospitals, and more doctors and nurses. I hope that my hon. Friend will do what I do, which is to contrast the growth in the national health service now with the reductions that took place under the Conservatives.
Mr. Peter Lilley (Hitchin and Harpenden): Is the Secretary of State not aware that patients cannot choose to use facilities in their own region, let alone in others, unless their health authority has contracted to purchase care at those facilities? Patients have to follow the money, but surely money should follow patients. If the Secretary of State has done a U-turn on this issue, is he aware that there is more joy in heaven over one sinner who repents? We shall not believe that he has repented, however, until he withdraws the circular that forbids patients to choose care at a facility with which their local authority does not have a contract.
Mr. Milburn: When the right hon. Gentleman was in government, he was never one to practise humility, as I remember. So far as the issue of money following patients is concerned, it is true that that is what the internal market, which he and his right hon. and hon. Friends devised, was supposed to achieve. But it never did. The money did not follow the patient; the patient ended up following the money, because the Conservatives had the absurd idea that the only way to raise standards in NHS hospitals was to foment competition among them. That was a failure then and, if we did it now, it would be a failure now.
Mr. Alan Simpson (Nottingham, South): Will the Secretary of State look carefully at the number of health authorities that actually pay for what they have purchased, rather than at those that purchase outside their area? In my area, two hospital truststhe Queen's medical centre and Nottingham city hospitalregularly have to carry bills of about £1 million each for extra-contractual referrals from other areas. Those bills do not get paid. It is one thing to ask hospitals to meet their own targets; it is another thing to ask them to meet other people's targets using their own financial allocations.
Mr. Milburn: My hon. Friend makes an extremely good point. Incidentally, he has two very good hospitals in his city, as he well knows. The system of extra-contractual referrals has gone. It was part and parcel of the internal market, which has now been replaced by a new system. He is quite right, however, to say that there is a faultline in the new system. When a hospital takes patients from outside its area, we do not recompense it immediately.
Dr. Evan Harris (Oxford, West and Abingdon): The tests for use of the private sector surely include value for money and accountability. Would it not deliver better value for money to free up the beds currently blocked in the health authorities where the Secretary of State is paying private companies over the odds to treat patients abroad, before trying the latter option? How can he demonstrate accountability when health authorities will not release to the House the value of the contracts to treat patients abroad, saying only that it is less than the very high cost that they are payingover the oddsfor private care in this country? How can that value for money be demonstrated in an accountable way?
Mr. Milburn: It is a nice, simple world that the Liberal Democrats live in, where there is always a simple solution to every problem. There is not a simple solution to the problems in the national health service. We have to grow the capacity in the NHS, use it where we can elsewhere, and put the reforms in place. It is not simply a question of using spare capacity in the private sector, or of freeing up capacity in the NHS. The hon. Gentleman is quite right; we are trying to get the number of delayed discharge patients down by investing more in social services, and by providing intermediate care, rehabilitation and other forms of care. We are doing all those things, not just one of them.
The hon. Gentleman knows as well as I do that the so-called secret contract between the primary care group and the hospitals in France is being evaluated. The primary care group will have to account for how it spends its share of the public money that it receives.
Tim Loughton (East Worthing and Shoreham): I am sure that we were all pleased for the nine NHS escapees who hobbled off for treatment at the private clinic in Lille last week. They will have been waved off enviously by the 1 million-plus patients who remain on waiting lists at home, not least the 42,000 and rising who have been waiting for more than a year. Will the Secretary of State now have another go at telling us exactly how much the treatment in Lille costs, including the associated travel costs, compared with the treatment available at private and not-for-profit centres here? Given the press reports about looking at using hospitals in Turkey, Tunisia and Malta, will he tell us just how far afield he is prepared to send our constituents before he gets to grips with the worsening crisis in treatment at home and puts an end to this national humiliation?
Mr. Milburn: I do not think that it is a national humiliation to get more NHS patients treated more quickly. I know that the Conservatives never managed to achieve that, but that is what is happening. I have a little tip for the hon. Gentleman: he should not believe everything that he reads in the newspapers. It will make him a very unhappy personI candidly tell him that, on occasions, it makes me very unhappy.
There are no deals with other countries. We have one deal in a pilot scheme between one primary care group and one hospital in France. As for escapees from the national health service, there is one policy that the Conservatives would carry out: they would make every NHS patient an escapee, because they want to abandon the national health service.
The Parliamentary Under-Secretary of State for Health (Ms Hazel Blears): In February last year, we approved plans for a £101 million major redevelopment in Plymouth, which will significantly increase the capacity of the hospital.
Mr. Streeter: The Minister refers to a new hospital that will come on stream in six or seven years, but what about levels of care for my constituents in the meantime? Given that the Government's own commission reported at the end of last year that it has been discovered that activity levels at Derriford hospital in Plymouth are three times higher than the national average, but that resources for the hospital are less than twice as high as the national average, is not the problem of the long-term funding structure the real reason why it often performs at 102 per cent. of capacity, why doctors and nurses are so hard pressed, and why so many operations are cancelled? After five years of a Labour Government, how much longer must my constituents wait for proper acute hospital health care?
Ms Blears: It is true that there are problems of capacity in this country, and it is no wonder, because under the previous Government 60,000 beds were cut. Between 1980 and 1997, the NHS lost 60,000 beds. That is why there is a problem with capacity. At long last, under this Government, we now have a scheme to rebuild Derriford hospital.
What has already happened at Derriford? [Interruption.] Let Opposition Members listen to what has already happened at Derriford: £6 million for a new cardiac unit; £3.5 million for a new cancer centre; £1.5 million for a new breast care unit; £820,000 for additional critical care beds; £765,000 for A and E modernisation; a new 10-bed observation ward planned in accident and emergency; four new wards for cardiac patients; and three wards to be released. That is just in Derriford. The rest of the country is also benefiting from the Labour Government, whereas people had to wait for years and years under the Tories.
Linda Gilroy (Plymouth, Sutton): Does my hon. Friend agree that primary care trusts have an increasingly important role to play in easing not just winter pressures but all the seasonal pressures that affect hospitals these days? Does she further agree that private insurance has absolutely no role to play in solving those problems and, indeed, would make matters worse for many of my constituents?
My hon. Friend is absolutely right. Getting hospitals to work well is not just the responsibility of the acute trusts; it also depends on primary care trusts, on social services working together and on the whole health community coming together to achieve that. I am aware that senior managers are working in each other's organisations. Anne James, chief executive of Plymouth City primary care trust, has recently spent some time working in accident and emergency. What better way for professionals to experience the problems that they all face across the piece? I am delighted that, in this area, people are looking to modernisation and reform as well as investment.